A guide to psoriasis symptoms, causes and treatments

Published February 2023 | 6 min read
Expert contributors Associate Professor Stephen Shumack, dermatologist and Clinical Associate Professor at the Sydney Medical School; Associate Professor Deshan Sebaratnam, dermatologist
Words by Sophie Al-Bassam

This common skin condition can be debilitating and affect many areas of your life. Here’s how you can get the right treatment for psoriasis and start feeling better.

Your skin is your biggest organ, so when you experience problems with it, like psoriasis, life can be challenging.

Psoriasis is an autoimmune disease that causes your immune cells to attack healthy tissue, which causes the deepest layer of skin to produce new skin cells quicker than usual. This usually causes red, scaly dry patches on your skin called plaques. If left untreated, psoriasis can cause serious complications like arthritis and diabetes.

“Psoriasis normally starts as some scaling on the elbows or the knees, or sometimes some dandruff. Sometimes [there’s] a bit of redness on other areas of the body such as the eyebrows, sometimes the lower legs or the trunk. Often [the scales and patches] are itchy,” says Associate Professor Stephen Shumack, dermatologist and Clinical Associate Professor at the Sydney Medical School.

It’s a common, chronic condition that can be long term, affecting around 2.5% of Aussies and it tends to go through cycles of flaring up and subsiding. It can affect men and women at any age, but it usually begins in your 30s. Around 75% of people with psoriasis get it before age 45. Psoriasis is not contagious.

Symptoms of psoriasis

Symptoms can vary based on which type of psoriasis you have, but they include:

• dry, scaly, red patches of skin
• dents and discolouration of your nails
• swollen, painful joints
• an itching or burning sensation.

The impact of the condition goes beyond how it looks, says Associate Professor Deshan Sebaratnam, dermatologist at Liverpool Hospital and senior lecturer at UNSW.

“It may have a significant impact on all aspects of life – work, study, family, friends, relationships, sleep. These all have knock-on effects on each other, too.”

Living with psoriasis and the associated pain can be debilitating. People who are diagnosed with it have an 11.5% increased risk of depression, and that risk jumps to 25% if you have severe psoriasis.

Psoriasis patients can feel embarrassment due to the visible physical nature of the condition and as a result, it can negatively affect their mental health. A study of 936 patients found that the problems most people frequently experienced with psoriasis were shame, anger, worry, difficulties in daily activities and social life.

Stress is also a common trigger for psoriasis flares, and according to the National Psoriasis Foundation, can make the itching worse, which makes stress management an important aspect of managing psoriasis.

The different types of psoriasis

The most common type of psoriasis is plaque psoriasis, which affects up to 90% of people with the condition. The main symptoms include raised, red patches of skin. Plaque psoriasis often accompanies nail psoriasis, which can result in discoloration, pitting or separation of the nail from the nail bed.

Other types of psoriasis include:

• guttate psoriasis, which usually occurs after a viral infection. Symptoms include small, teardrop-shaped lesions
• pustular psoriasis, which is rare. Symptoms include small blisters containing pus on top of red skin. It can develop suddenly and progress quickly, and can cause severe illness
• erythrodermic psoriasis, which is also rare and can be serious, causing fever and dehydration. Symptoms include red, inflamed areas all over your body. It usually develops in people with a history of plaque psoriasis.

Psoriasis and your immune system

Your immune system is a powerhouse trained to fight invaders like infection, bacteria and toxins. But in people with psoriasis, immune cells attack healthy cells by mistake. This causes inflammation of the skin and sometimes other organs, too.

People with psoriasis have a higher risk of developing other health conditions, including diabetes, obesity, high cholesterol, high blood pressure, heart disease and inflammatory bowel diseases like Crohn’s disease. Getting treatment for psoriasis can lower the risk of these conditions.

Around 30% of people with psoriasis also have psoriatic arthritis, a chronic, inflammatory disease of the joints.

What causes psoriasis?

Experts don’t know what causes psoriasis but suggest it may be due to an overactive immune system.

You’re more likely to have psoriasis if it runs in your family. At least 10% of people inherit the mix of genes that make them more likely to have it, but scientists are still working out the link between these genes and the condition itself.

There are various triggers for psoriasis that can kick off the condition or make it worse.

You can develop psoriasis after getting an infection, like streptococcal tonsillitis or an ear infection. In this case, treating the infection can help manage your psoriasis.

Although your diet doesn’t cause psoriasis, certain foods can cause inflammation in your body, increasing your risk of the condition. Alcohol, highly processed foods and foods high in fat and sugar can all increase inflammation. They can also increase your risk of other conditions like obesity, diabetes and heart disease. Reducing highly processed foods can help.

Other triggers include:

• stress
• injury to the skin, like scratches, sunburns and bug bites
• smoking
• some medications
• hormonal changes like menopause.

Even changes in the weather impact psoriasis, says Assoc Prof Sebaratnam. “In winter psoriasis tends to be a little worse.”

How can you treat psoriasis?

Psoriasis can usually be diagnosed and treated by a GP.

If you have severe psoriasis, you may need to see a skin specialist like a dermatologist. You can use our Find a Provider search tool to find a dermatologist near you and read their biography, locations and contact details. Psoriasis is usually treated by one or a combination of the following therapies.

Topical treatment

“These days creams or ointments or sprays actually work very well. These can be prescribed by your general practitioner or dermatologist,” says Assoc Prof Shumack.

These topical treatments are usually the first thing to try for mild psoriasis.

Light therapy

Ultraviolet light therapy slows down the production of skin cells. It’s a good option for psoriasis that hasn’t responded to topical treatment.

Medications

If your psoriasis is not responding to other treatment, you may be prescribed oral or injected medications by your GP or a dermatologist to lessen the immune response.

Lifestyle changes

Assoc Prof Shumack says you can also improve your psoriasis with lifestyle changes. “Getting a significant amount of sleep will help with psoriasis. A little bit of sun exposure (though not to the point of sunburn) will also help keep psoriasis at bay.”

Need to see a GP?

Psoriasis is a condition that needs to be looked at and diagnosed by your GP.

If you need a referral to a dermatologist or other specialist who can help, or want to chat about new treatment options, speak to your GP. While an in-person visit is generally better, our partnership with GP2U, an online video GP service, makes it easier for you to access telehealth services. Through our partnership with GP2U, all HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50. See hcf.com.au/gp2u for more information.